<!DOCTYPE html>
<html lang="en" xmlns:th="http://www.thymeleaf.org">
	<head>
		<meta charset="utf-8">
		<title>绑定医保卡</title>
		<script src="https://stackpath.bootstrapcdn.com/bootstrap/3.4.1/js/bootstrap.min.js" integrity="sha384-aJ21OjlMXNL5UyIl/XNwTMqvzeRMZH2w8c5cRVpzpU8Y5bApTppSuUkhZXN0VxHd" crossorigin="anonymous"></script>
		<link th:href="@{/bootstrap/bootstrap.min.css}" rel="stylesheet">
		<link th:href="@{/css/dt-login.css}" rel="stylesheet">
		<link rel="stylesheet" type="text/css" href="css/departmentCss/base.css">
	<link rel="stylesheet" type="text/css" href="css/departmentCss/layout.css">
	<link rel="stylesheet" type="text/css" href="css/departmentCss/zebra_dialog.css">
    <link rel="stylesheet" type="text/css" href="css/appointmentCss/secondary.css">
    <link rel="stylesheet" href="css/userCenter.css">
    <link rel="stylesheet" href="css/footer.css">
	</head>

	<body>
		<div class="header">
	        <div class="wrapper clearfix">
	            <div class="logo">
	                <a id="headBaseConfigWebTitle" href="javascript:void (0)" style="cursor: text;">青山门诊预约挂号</a>
	            </div>
	        </div>
	    </div>
		<div class="topNav">
	        <div class="wrapper">
	            <div class="topNav_menu">
	                <ul class="clearfix">
	                    <li>
	                        <a id="futureReservation" th:href="@{/department}" style="pointer-events: none;">首页</a>
	                    </li>
						<li class="last">
							<a href="appointment.html" style="pointer-events: none;">我的中心</a>
						</li>
	                </ul>
	            </div>
	        </div>
	    </div>
	    <div class="main">
		    <div class="wrapper clearfix">
		        <p class="mt30 clearfix">
		            <input type="hidden" id="timeType" value="2">
		            <span class="fl"> <a th:href="@{/department}" style="pointer-events: none;">首页</a>
							&gt; <a href="javascript:void(0)" style="text-decoration: none;cursor: text;">  绑定就诊卡</a>
						</span>
		        </p>
		    </div>

			<div class="rg_containner">
				<div class="rg_center" >
			    <form th:action="@{/bindCard}" method="post">
			        <table>
			            <tr>
			                <td class="td_left"><label for="uuid">就诊卡</label></td>
			                <td class="td_right"><input type="text" name="uuid" id="uuid" th:value="${uuid}" placeholder="请输入就诊卡号" required></td>
			            </tr>
			            <tr>
			                <td class="td_left"><label for="name">姓名</label></td>
			                <td class="td_right"><input type="text" name="name" id="name" placeholder="请输入姓名 " required></td>
			            </tr>
			            <tr>
			                <td class="td_left"><label for="tel">手机号</label></td>
			                <td class="td_right"><input type="text" name="tel" id="tel" placeholder="请输入手机号" required></td>
			            </tr>
			            <tr>
			                <td class="td_left"><label for="tel">身份证号</label></td>
			                <td class="td_right"><input type="text" name="id" id="id" placeholder="请输入身份证号" required></td>
			            </tr>
			            <tr>
			                <td class="td_left"><label>性别</label></td><td class="td_right">
			                    <input type="radio" name="gender" value="0"> 男
			                    <input type="radio" name="gender" value="1"> 女
			                </td>
			            </tr>
			 
			            <tr>
			                <td class="td_left"><label for="age">年龄</label></td>
			                <td class="td_right"><input name="age" id="age" placeholder="请输入年龄" required></td>
			            </tr>
			            <tr>
			                <td colspan="2" align="center"><input type="submit" id="btn" value="确定"></td>
							<td colspan="2" align="center"><a th:href="@{/loginOut}">取消</a></td>
			            </tr>
			        </table>
			    </form>
			</div>
			</div>
			
		</div>	
		<footer class="main-footer">
	        <div class="footer_box">
	            <div class="pull-right hidden-xs">
	                <b>All rights reserved</b>
	            </div>
	            <strong>Copyright &copy; 2021-11 
	                <a href="javascript:void(0)">信工研究院研发部</a>.
	            </strong>  
	        </div>   
		</footer>
	</body>
</html>
